title: Incidence of heparin-induced thrombocytopenia type II and postoperative recovery of platelet count in liver graft recipients: a retrospective cohort analysis.
abstract: BACKGROUND
  Thrombocytopenia in patients with end-stage liver disease is a common disorder caused mainly by portal hypertension, low levels of thrombopoetin, and endotoxemia. The impact of immune-mediated heparin-induced thrombocytopenia type II (HIT type II) as a cause of thrombocytopenia after liver transplantation is not yet understood, with few literature citations reporting contradictory results. The aim of our study was to demonstrate the perioperative course of thrombocytopenia after liver transplantation and determine the occurrence of clinical HIT type II.
  
  
  METHODS
  We retrospectively evaluated the medical records of 205 consecutive adult patients who underwent full-size liver transplantation between January 2006 and December 2010 due to end-stage or malignant liver disease. Preoperative platelet count, postoperative course of platelets, and clinical signs of HIT type II were analyzed.
  
  
  RESULTS
  A total of 155 (75.6%) of 205 patients had thrombocytopenia before transplantation, significantly influenced by Model of End-Stage Liver Disease score and liver cirrhosis. The platelet count exceeded 100,000/μL in most of the patients (n = 193) at a medium of 7 d. Regarding HIT II, there were four (1.95%) patients with a background of HIT type II.
  
  
  CONCLUSIONS
  The incidence of HIT in patients with end-stage hepatic failure is, with about 1.95%, rare. For further reduction of HIT type II, the use of intravenous heparin should be avoided and the prophylactic anticoagulation should be performed with low-molecular-weight heparin after normalization of platelet count.
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, University of Tübingen, Tübingen, Germany. Electronic address: robert.bachmann@med.uni-tuebingen.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Bachmann
authors.forename: Jeannine
authors.initials: J
authors.lastname: Bachmann
authors.forename: Jessica
authors.initials: J
authors.lastname: Lange
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
authors.forename: Ruth
authors.initials: R
authors.lastname: Ladurner
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000097:blood / Q000601:surgery; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Anticoagulation; Heparin-induced thrombocytopenia; High-risk recipient; Liver transplantation